Disproportionate Pregnancy-Induced Myocardial Hypertrophy in Women With Essential Hypertension

Author(s)

Zanati Bazan, Silmeia Garcia ^[1] ; Borges, VeraTherezinha Medeiros ^[2] ; Martin, Luis Cuadrado ^[1] ; Magalhaes, Claudia Garcia ^[2] ; Hueb, Joao Carlos ^[1] ; de Arruda Silveira, Liciana Vaz ^[3] ; Peracoli, Jose Carlos ^[2] ; Matsubara, Beatriz Bojikian ^[1]

Affiliation

^[1] Sao Paulo State Univ, UNESP, Botucatu Med Sch, Dept Internal Med, Sao Paulo - Brazil

^[2] Sao Paulo State Univ, UNESP, Botucatu Med Sch, Dept Gynecol & Obstet, Sao Paulo - Brazil

^[3] Sao Paulo State Univ, UNESP, Dept Biostat, Biosci Inst, Sao Paulo - Brazil

• Document type: Journal article
• Source: AMERICAN JOURNAL OF HYPERTENSION; v. 26, n. 6, p. 816-821, JUN 2013.
• Web of Science Citations: 5

Abstract

BACKGROUND Pregnancy and arterial hypertension (AH) have a prohypertrophic effect on the heart. It is suspected that the 2 conditions combined cause disproportionate myocardial hypertrophy. We sought to evaluate myocardial hypertrophy (LVH) and left ventricular function in normotensive and hypertensive women in the presence or absence of pregnancy. METHODS This prospective cross-sectional study included 193 women divided into 4 groups: hypertensive pregnant (HTP; n = 57), normotensive pregnant (NTP; n = 47), hypertensive nonpregnant (HTNP; n = 41), and normotensive nonpregnant (NTNP; n = 48). After clinical and echocardiographic evaluation, the variables were analyzed using 2-way analysis of variance with pregnancy and hypertension as factors. Left ventricular mass (LVM) was compared using nonparametric analysis of variance and Dunn's test. Predictors of LVH and diastolic dysfunction were analyzed using logistic regression (significance level, P < 0.05). RESULTS Myocardial hypertrophy was independently associated with hypertension (odds ratio (OR) = 11.1, 95% confidence interval (CI) = 3.2-38.5; P < 0.001) and pregnancy (OR = 6.1, 95% CI = 2.6-14.3; P < 0.001) in a model adjusted for age and body mass index. Nonpregnant women were at greater risk of LVH in the presence of AH (OR = 25.3, 95% CI = 3.15-203.5; P = 0.002). The risk was additionally increased in hypertensive women during pregnancy (OR = 4.3, 95% CI = 1.7-10.9; P = 0.002) in the model adjusted for stroke volume and antihypertensive medication. Although none of the NTNP women presented with diastolic dysfunction, it was observed in 2% of the NTP women, 29% of the HTNP women, and 42% of the HTP women (P < 0.05). CONCLUSIONS Hypertension and pregnancy have a synergistic effect on ventricular remodeling, which elevates a woman's risk of myocardial hypertrophy. (AU)